A COMPARISON OF LABOR AND DELIVERY MANAGEMENT BETWEEN NURSE MIDWIVES AND FAMILY PHYSICIANS

Background. Practice associations between family physicians and nurse midwives have been suggested as a means to increase the availability o f obstetric care in rural areas. No evidence exists, however, that fam ily physicians and midwives have comparable practice styles or achieve similar outcomes in obstetric patients. Methods. The study examines p atients cared for by a co-practice of nurse midwives and family physic ians at a rural hospital. Data were collected through a retrospective chart audit for all patients whose prenatal care, labor, or delivery w as managed by members of the practice in 1990 and 1991. Results. Few d ifferences were noted between nurse midwives and family physicians in the management of labor or delivery. The only consistent finding was t hat family physicians were more likely than midwives to use an episiot omy for delivery (40% vs 30% in primiparous women, P = .02; and 20% vs 10% in multiparous women, P = .007). Despite seemingly similar manage ment styles, primiparous women managed by family physicians were more likely to undergo cesarean section (14% vs 8%, P = .05) resulting from the diagnosis of dystocia. When practice specialty was included in a logistic regression model with parity and the number of preexisting ri sk factors, the effect of specialty on cesarean sections remained sign ificant with a relative risk of 2.79 for cesarean section if patients had their labor managed by a family physician (P < .001). Conclusions. Family physicians and nurse midwives managed patients in labor simila rly, but nurse midwives were more likely to achieve a vaginal delivery in primiparous women and do so without an episiotomy. Although the di fferences found would not interfere with a collaborative practice, sub tle differences in patient management do exist. Further exploration of these differences may be helpful in understanding the impact of these differences on mixed-specialty practices.